Intrauterine insemination with gonadotropin stimulation or in vitro fertilization for the treatment of unexplained subfertility: a randomized controlled trial

Anupa Nandi, Priya Bhide, Richard Hooper, Anil Gudi, Amit Shah, Khalid S. Khan, Roy Homburg
In: Fertility and Sterility · 2017 · vol. 107(6) , pp. 1329–1335.e2 · doi:10.1016/j.fertnstert.2017.03.028 · PMID:28501361 · W2612438784
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One cycle of IVF did not significantly differ in singleton live birth rate from three cycles of intrauterine insemination with gonadotropin stimulation for unexplained subfertility.

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Abstract

ObjectiveTo evaluate the best first line management option for the treatment of unexplained subfertility-controlled ovarian hyperstimulation (COH) with gonadotropins and IUI or IVF.DesignRandomized controlled trial.SettingSingle center trial in a tertiary referral unit.Patient(s)Couples with unexplained subfertility.Intervention(s)Couples were randomized to receive either three cycles of IUI + COH or one cycle of IVF.Main outcome measure(s)Singleton pregnancy rate (PR) per couple.Result(s)A total of 207 couples were randomly assigned to three cycles of IUI + COH (n = 101) or one cycle of IVF (n = 106). There were 25 (24.7%) singleton live births for the IUI + COH group and 33 (31.1%) for the IVF group (relative risk, 1.3; 95% confidence interval [CI] 0.81-1.96) with an absolute risk difference of 6.4% (95% CI -5.8% to 18.6%). The multiple pregnancies per live birth were 4 (13.8%) for the IUI + COH group and 3 (8.3%) for the IVF group (relative risk, 0.6; 95% CI 0.14-2.4). There were no cases of ovarian hyperstimulation syndrome (OHSS) in the IUI group and three cases of OHSS (3.7%) in the IVF group. There were 17 live births from spontaneous conception in between treatment cycles (8.2%).Conclusion(s)The singleton live birth rate with one cycle of IVF was not significantly different than three cycles of IUI + COH.Clinical trial registration numberISRCTN43430382.

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